Polycystic ovarian syndrome is a complex disorder of the female reproductive organs and metabolism in women. It is very common and occurs in 7-10% of reproductive age women. It is the most common cause of irregular menstrual cycles and infertility in women. PCOS often begins around the time of puberty or after a period of rapid weight gain.
Some of the symptoms of PCOS include:
Excessive hair growth–usually on the face, chest or abdomen
Hair loss or thinning hair
Irregular or absent menstrual cycles
Infertility or repeat miscarriages
Changes in blood pressure
Elevated blood cholesterol
Elevated fasting glucose
Depression and/or mood swings
What causes PCOS?
Though the exact cause of PCOS is unknown, there are many likely factors that are involved.
A key feature of PCOS is insulin resistance. Insulin is a hormone secreted by the pancreas and is involved in the metabolism of sugar and fat. Specifically, insulin signals the fat cells and muscle cells in the body to take sugar (and fat) out of the blood. When insulin resistance develops, these cells stop responding normally to the insulin signal. The body tries to overcome this resistance by making more insulin. As long as the body can make enough insulin, the blood sugar stays normal and diabetes does not develop. However, the high insulin level has adverse effects on the ovaries and disrupts the menstrual cycle.
People with a family history of PCOS or Type 2 Diabetes are much more likely to be diagnosed with PCOS.
In PCOS, the ovaries often produce too much androgens, or testosterone, and not enough estrogen or progesterone. These hormone imbalances are what contribute to the irregular menstrual cycles, acne, facial hair growth, infertility and ovarian cysts that patients with PCOS often experience.
How is PCOS Diagnosed and What Testing is Required?
A group of experts from the National Institutes of Health (NIH) proposed the following criteria which are used by most endocrinologists in the US to diagnose PCOS:
Menstrual disturbance– irregular or absent menses.
Hyperandrogenism– elevated effects of androgens (masculinizing hormones) manifest by acne, extra hair growth, balding, and/or elevated blood androgen levels (e.g. testosterone)
Exclusion of other causes– such as pregnancy, thyroid problems, high prolactin levels, early menopause.
To diagnose PCOS, your doctor will typically listen to your history and will perform a physical exam. Blood testing is typically performed to evaluate hormone levels and rule out other causes of irregular menstrual cycles. Once your doctor is sure you are not pregnant, you may be asked to perform a “progesterone withdrawal challenge.” For this test, you will take a progesterone (e.g. Provera, medroxyprogesterone, Prometrium) daily for 10 days. Most women with PCOS will have menstrual bleeding within several days after the progesterone is stopped.
In addition, An ultrasound of the ovaries to look for cysts may be recommended by your physician. This is because 25% of women with PCOS may have normal appearing ovaries (but will still respond to treatment) and 25% of women without PCOS have cystic ovaries.
What is the Treatment for PCOS?
PCOS may be treated with lifestyle changes, targeted supplementation, medications, or all of the above. The choice of therapy depends on many factors, including desire for pregnancy, preference for medical vs. non-medical therapy, and individual circumstances. Other important factors such as adrenal health and thyroid productivity will also be evaluated.
Healthy eating–The diet should be adjusted to provide good nutrition and to limit saturated fat. For women who are overweight, portion sizes and calories should be restricted to help promote weight loss.
Exercise–Regular aerobic exercise can reduce insulin resistance and help promote normal metabolism and menstrual cycles. Ideally you should obtain 30 minutes of exercise on most days of the week (all in one session or in multiple smaller sessions). You may wish to discuss with your doctor whether you need any additional testing, like a treadmill test, before beginning an exercise program.
Medications may be used to help treat the effects of PCOS, and are tailored to each individuals needs, desire for pregnancy, etc. These medications will often help to decrease insulin resistance, treat excess androgen, and treat infertility.
There are many supplements and herbs that are useful in stimulating ovulation, reducing ovarian cysts and re-balancing female reproductive hormones. Your physician will work with you to create an individualized treatment plan.
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